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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880596
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:40:19 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2021 and conducted by Evaluator Natalie Ibarra
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210408131507
FACILITY NAME:CAROLINE STREETFACILITY NUMBER:
361880596
ADMINISTRATOR:UNIQUE WATKINSFACILITY TYPE:
735
ADDRESS:14461 CAROLINE STTELEPHONE:
(442) 249-1310
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY:4CENSUS: DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Kolice SattiewhiteTIME COMPLETED:
11:42 AM
ALLEGATION(S):
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Resident being injured at the facility
Resident not receiving diet as ordered
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero made an unannounced visit to the facility to deliver findings for the above allegations. LPA met with Licensee Kolice Sattiewhite and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties and records review.

The first allegation indicates resident being injured at the facility. Interviews with Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3) stated Client #1 (C1) is not being injured at the facility nor what they witness staff causing any type of injury to client. S1, S2, and S3 stated they haven't heard of C1 having any type of pain to either side of his abdominal area. S3 stated the facility is no-hit facility and C1 is treated well. Interview with C1’s former case manager at Inland Regional Center (IRC) stated that the allegation was brought to their attention and it was investigated. Per investigation C1 is not being injured at facility and has no concern with how facility staff are treating C1. C1’s current IRC case manager stated they do not have concerns with the facility nor how they treat C1. Facility has been very accommodating to C1’s needs.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20210408131507
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CAROLINE STREET
FACILITY NUMBER: 361880596
VISIT DATE: 11/02/2022
NARRATIVE
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The second allegation indicates resident not receiving diet as ordered. S1 stated the facility during this time was doing a weight loss challenge with the clients at the facility reason why C1 was losing weight. Facility was increasing walking and activities to avoid client from gaining weight, keep them healthy, and something to do during COVID. C1’s doctor and social worker are aware of C1’s weight loss. S2 and S3 stated C1 eats regular meals and is also being taken to the gym regularly. S2 and S3 stated per doctor’s order C1 was to lose weight for health reason. C1’s IRC case workers stated they had no concerns with C1’s weight lose and that facility is following doctor’s recommendations in assisting C1 to lose weight. LPA reviewed recent nutritional recommendations for C1 that states to follow a 2,000-calorie meal plan with portions. LPA also reviewed C1’s Individual Program Plan (IPP) that states C1 is to follow a calorie diet per doctor’s orders.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was discussed and provided to Kolice Sattiewhite
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2